What laboratory tests are ordered for an initial office visit for an adult patient?

Laboratory Tests for Initial Adult Office Visit

For an initial office visit with an adult patient, a comprehensive panel of laboratory tests should include complete blood count, comprehensive metabolic panel, lipid profile, thyroid-stimulating hormone, urinalysis, and hemoglobin A1c. 1, 2

Core Laboratory Tests

Basic Tests (Recommended for All Adult Patients)

• Complete Blood Count (CBC) with platelets 1, 2
• Comprehensive Metabolic Panel including:
  • Serum electrolytes (sodium, potassium, calcium) 1
  • Blood urea nitrogen (BUN) 1
  • Serum creatinine with estimated glomerular filtration rate (eGFR) 1
  • Fasting blood glucose 1
  • Liver function tests 1
• Lipid Profile including:
  • Total cholesterol
  • LDL cholesterol
  • HDL cholesterol
  • Triglycerides 1
• Thyroid-Stimulating Hormone (TSH) 1
• Urinalysis 1
• Urine Albumin-to-Creatinine Ratio (preferred over dipstick urinalysis for detecting early kidney disease) 1
• Hemoglobin A1c (for screening and baseline assessment) 1

Additional Tests Based on Age and Risk Factors

• For patients ≥65 years:

  • Consider assessment for cognitive performance 1
  • Consider assessment for functional performance 1
  • Vitamin B12 levels (especially if on metformin) 1

• For patients with hypertension or cardiovascular risk:

  • Electrocardiogram (ECG) 1
  • Consider echocardiogram for those with symptoms or signs of heart disease 1

• For patients with obesity:

  • Screening for obstructive sleep apnea (questionnaires like STOP-BANG) 1
  • Consider liver function tests to screen for non-alcoholic fatty liver disease 1

Risk-Based Additional Testing

For Patients with Diabetes or Prediabetes

• Vitamin B12 if on metformin 1
• Spot urinary albumin-to-creatinine ratio 1
• Consider dilated eye examination referral 1

For Patients with Suspected Heart Failure

• BNP/NT-proBNP 1, 2
• Consider echocardiography 1
• Consider coronary artery disease evaluation in appropriate patients 1

For Patients with Suspected Kidney Disease

• Serum potassium levels (especially if on ACE inhibitors, ARBs, or diuretics) 1
• Urine protein/creatinine ratio 1, 2

Important Considerations

• Laboratory results should be interpreted in clinical context and abnormal results should prompt appropriate follow-up testing 2
• Point-of-care testing may reduce wait times but may not be available in all settings 3
• While comprehensive testing provides valuable baseline information, it's important to avoid unnecessary testing that doesn't impact clinical decision-making 4
• Laboratory testing should be part of a broader assessment that includes medical history, physical examination, and evaluation of social determinants of health 1

Common Pitfalls to Avoid

• Overreliance on normal laboratory values: Normal results don't exclude disease, especially early in its course
• Inadequate screening for albuminuria: Using dipstick alone rather than albumin-to-creatinine ratio may miss early kidney disease 1
• Failure to assess for metabolic syndrome components: Waist circumference measurement along with laboratory values provides better identification of insulin resistance 5
• Not repeating abnormal values: Confirm unexpected abnormal results before making treatment decisions
• Missing follow-up: Ensure systems are in place to communicate results and arrange appropriate follow-up based on findings

By following this comprehensive laboratory assessment approach, you'll establish an important baseline for your adult patients and identify potential health issues requiring further evaluation or management.